How should we manage children after mild head injury?

There are many controversies concerning the management of children after mi ld head injury. Most of these patients achieve a full recovery without medi cal or surgical intervention. A small percentage of them deteriorate owing to intracranial complications. The goal of this study was to identify signi ficant factors that might allow the identification of patients at risk of s ubsequent deterioration. Its secondary goal was to establish a clinical pro tocol for the management of mild head injuries in children. We retrospectiv ely reviewed the records of 166 children and adolescents with head trauma w ho had Glasgow Coma Scale (GCS) or Children Coma Scale (CCS) scores of 13-1 5 at the time of admission. The patients were divided into five age categor ies: babies younger than 1 year, children 1-3, 4-6, and 7-14 years old, and adolescents 15-17 years of age. The largest age group consisted of childre n 7-14 years old (83 cases). There was a male predominance (2:1). The main causes of injury were traffic accidents (55 cases) and falls (53 patients). Neurosurgical procedures were required in 93 of the 166 patients (56%). Th e most common intracranial lesion was subdural and epidural hematoma (60 ca ses). In 26 children (15.6%) diffuse brain swelling was the only lesion. A skull fracture was found in 103 cases and was accompanied by epidural hemat oma (HED) in 19 cases (18%) and by subdural hematoma (HSD) in 12 cases (12% ). However, the 63 children Without a fracture also included 18 (29%) who h ad HSD and 11 (17%) who had HED. In our population 165 (99%) of the patient s obtained a very good or good result. None was left severely disabled or i n a vegetative state. One patient with GCS 13 died of an infection. We conc luded that skull X-ray examination is not sufficient to rule out intracrani al hematoma, We recommend CT scanning and admission to hospital for 24-h ob servation for all children with minor head injury, because of the risk of d elayed hematoma.